Chest X-ray Analysis Research Articles

Preoperative Left Ventricular Diastolic Dysfunction Is Associated with Pulmonary Edema after Carotid Endarterectomy.

This retrospective study was aimed to investigate the association between preoperative left ventricular (LV) cardiac function and the incidence of postoperative pulmonary edema (PE) in patients undergoing carotid endarterectomy (CEA). Most patients undergoing CEA for carotid artery stenosis have concomitant heart diseases, leading to hemodynamic instability that can cause postoperative cardiac complications such as cardiac heart failure. LV diastolic function has recently been recognized as an independent predictor of adverse cardiac events in patients undergoing cardiovascular surgery. We analyzed clinical data from the anesthetic and medical records of 149 consecutive patients who underwent CEA at our university hospital between March 2012 and March 2018. LV systolic and diastolic function were evaluated by ejection fraction and the ratio of LV early diastolic filling velocity to the peak velocity of mitral medial annulus (E/e′). Postoperative PE was diagnosed based on chest X-ray and arterial gas analysis by two independent physicians. Postoperative PE was developed in four patients (2.8%). Patients with postoperative PE were not related to preoperative low ventricular ejection fraction, but had a significantly higher E/e′ ratio than those without PE (P = 0.01). Furthermore, there was an increasing trend of PE according to the E/e′ category. Preoperative LV diastolic function evaluated by E/e′ was associated with the development of postoperative PE in patients who underwent CEA. The results suggest that the evaluation of LV diastolic dysfunction could be possibly useful to predict PE in patients undergoing CEA.

Feature Extraction of Chest X-ray Images and Analysis using PCA and kPCA

<p class="abstract">Tuberculosis (TB) is an infectious disease caused by mycobacterium which can be diagnosed by its various symptoms like fever, cough, etc. Tuberculosis can also be analyzed by understanding the chest x-ray of the patient which is revealed by an expert physician .The chest x-ray image contains many features which cannot be directly used by any computer system for analyzing the disease. Features of chest x-ray images must be understood and extracted, so that it can be processed to a form to be fed to any computer system for disease analysis. This paper presents feature extraction of chest x-ray image which can be used as an input for any data mining algorithm for TB disease analysis. So texture and shape based features are extracted from x-ray image using image processing concepts. The features extracted are analyzed using principal component analysis (PCA) and kernel principal component analysis (kPCA) techniques. Filter and wrapper feature selection method using linear regression model were applied on these techniques. The performance of PCA and kPCA are analyzed and found that the accuracy of PCA using wrapper approach is 96.07% when compared to the accuracy of kPCA which is 62.50%. PCA performs well than kPCA with a good accuracy.</p>

Visualization and Interpretation of Convolutional Neural Network Predictions in Detecting Pneumonia in Pediatric Chest Radiographs.

Pneumonia affects 7% of the global population, resulting in 2 million pediatric deaths every year. Chest X-ray (CXR) analysis is routinely performed to diagnose the disease. Computer-aided diagnostic (CADx) tools aim to supplement decision-making. These tools process the handcrafted and/or convolutional neural network (CNN) extracted image features for visual recognition. However, CNNs are perceived as black boxes since their performance lack explanations. This is a serious bottleneck in applications involving medical screening/diagnosis since poorly interpreted model behavior could adversely affect the clinical decision. In this study, we evaluate, visualize, and explain the performance of customized CNNs to detect pneumonia and further differentiate between bacterial and viral types in pediatric CXRs. We present a novel visualization strategy to localize the region of interest (ROI) that is considered relevant for model predictions across all the inputs that belong to an expected class. We statistically validate the models’ performance toward the underlying tasks. We observe that the customized VGG16 model achieves 96.2% and 93.6% accuracy in detecting the disease and distinguishing between bacterial and viral pneumonia respectively. The model outperforms the state-of-the-art in all performance metrics and demonstrates reduced bias and improved generalization.

Case Report: Ostium secundum atrial septal defect with unilateral lung hypervascularity revealing associated right pulmonary artery stenosis

Background: Atrial septal defect (ASD) is often an isolated disease, but its association with other abnormalities can make diagnosis challenging. Careful analysis of simple complementary exams can help precise anatomical diagnosis ensuring suitable treatment. The aim of this article is to report, from a case report and literature review, diagnostic challenges and the contribution of simple complementary exams, such as chest X-ray, for the diagnostic orientation of an ASD associated with peripheral pulmonary artery stenosis, as well as therapeutic particularities. Case report: We report the case of a girl born in 2007, with history of dyspnoea and recurrent bronchitis in whom a loud systolic murmur was detected fortuitously at the age of 2 years. Her clinical examination was otherwise normal. The electrocardiogram recorded sinus rhythm, incomplete right bundle branch block, and right ventricular hypertrophy. Chest X-ray showed moderate cardiomegaly and hypervascularity of the left lung field contrasting with reduced blood flow to the right lung. Doppler echocardiography revealed a wide ostium secundum ASD, right chamber volume overload and right pulmonary artery stenosis. The latter was confirmed by CT angiography and right cardiac catheterization. The patient underwent percutaneous right pulmonary artery dilation with stent placement. Control chest X-ray noted bilateral hypervascularity of the lung. The ASD was closed percutaneously one year later. The outcome was uneventful. Conclusion: The combination of ASD with pulmonary artery stenosis limits pulmonary hyperflow. In our case, this stenosis was tight and sat on the right branch of the pulmonary artery reducing significantly blood flow to the ipsilateral lung. Careful chest X-ray analysis may suggest diagnosis, which can be confirmed by ultrasounds and if necessary, by further examination, allowing treatment adaptation. To our knowledge, this association is very rare and no similar case has been reported.

A novel stacked generalization of models for improved TB detection in chest radiographs.

Chest x-ray (CXR) analysis is a common part of the protocol for confirming active pulmonary Tuberculosis (TB). However, many TB endemic regions are severely resource constrained in radiological services impairing timely detection and treatment. Computer-aided diagnosis (CADx) tools can supplement decision-making while simultaneously addressing the gap in expert radiological interpretation during mobile field screening. These tools use hand-engineered and/or convolutional neural networks (CNN) computed image features. CNN, a class of deep learning (DL) models, has gained research prominence in visual recognition. It has been shown that Ensemble learning has an inherent advantage of constructing non-linear decision making functions and improve visual recognition. We create a stacking of classifiers with hand-engineered and CNN features toward improving TB detection in CXRs. The results obtained are highly promising and superior to the state-of-the-art.

Clinical profile, complications, morbidity and outcome of empyema thoracis in children in a tertiary care centre

Background: Empyema thoracis, an accumulation of pus in pleural space, occurs in 5-10% of children with bacterial pneumonia. Often cases are referred to the tertiary care hospital late resulting in significant complications, morbidity and mortality. Our aim was to study the clinical profile, associated complications, morbidity and treatment outcome of empyema in children.Methods: A prospective observational study was conducted on 65 children aged 0-12 yrs diagnosed with empyema thoracis admitted in the hospital. After history taking and clinical examination, relevant investigations like chest X-ray, USG chest and pleural fluid analysis including culture and sensitivity were done. All patients were treated with chest tube drainage, antibiotics and intrapleural fibrinolytic therapy.Results: Maximum patients (61.5%) were seen in age group 1-5 yrs, 18.4% below 1 year, 2 were neonates. Pleural fluid culture was positive in 64.6 % of patients. Staphylococcus aureus (58.4%) was the most frequent organism isolated from pleural fluid. Pyopneumothorax (36.9%), broncho-pleural fistula (27.6%) and pneumothorax (18.4%) were common complications. Broncho-pleural fistula was present at admission in 14 patients, developed later in 4 patients and healed with conservative management in 12 patients. Majority of the patients (n=51, 78.4%) had complete resolution of empyema thoracis with re-expansion of lung on conservative management alone. The success rate of medical management in patients who received intrapleural fibrinolytic (streptokinase) within 14 days of symptom onset was 93.3% while it was 71.4% in patients who received intrapleural fibrinolytic after 14 days. 5 (7.6%) patients died, 5 required surgical intervention(decortication/VATS), 4 patients with broncho-pleural fistula not improving on conservative management were referred to higher centre and were lost to follow-up.Conclusions: Empyema in children causes significant morbidity which can be reduced by prompt and adequate treatment of bacterial pneumonia. Antibiotics, chest tube drainage along with intrapleural fibrinolytic therapy is a safe and effective method to facilitate drainage and resolution of empyema even in cases with delayed presentation in resource poor settings and can reduce the need for surgery.

Etiological evaluation of convulsions in children from 1 month to 14 years of age

Background: Seizures are a common problem evaluated in the pediatric emergency departments worldwide. Objective: The objective of the study was to study the etiology of convulsions in children aged 1 month–14 years. Methods: This cross-sectional study was done among 120 children admitted to the pediatric ward of a tertiary care hospital with convulsions during the period of June 2014–May 2015. Complete blood count, blood sugar, serum calcium, magnesium, and electrolytes were done for all the children. Mantoux, chest X-ray, liver biopsy, electroencephalograph, lumbar puncture and cerebrospinal fluid analysis, ultrasonography cranium, computed tomography brain, or magnetic resonance imaging brain were done based on the clinical situation. Results: We found that 46.7% of the children had febrile seizures, 19.2% had seizure disorder, 15% had cerebral palsy, 5.8% had viral encephalitis, 3.3% had pyogenic meningitis, 1.7% had neurocysticercosis, 0.8% had metabolic disorders, and 0.8% had traumatic brain injury, and the cause of seizures was unknown in 6.6% of the children. Conclusion: Children with seizures need a thorough evaluation to identify the underlying pathology causing seizures.

Community-Acquired Bacterial Pneumonia and Comorbidity in Elderly Patients

We have analyzed the clinical course of pneumonia in 67 elderly patients (39 women and 28 men, the average age: 74.4 ± 5.2 years) with chronic heart failure and chronic obstructive pulmonary disease (COPD). The patients were divided into two groups: with COPD (group 1) and without COPD (group 2). Pharmacological treatment incorporating ampicillin and sulbactam was performed taking into account clinical laboratory indices (temperature, oxygen saturation, and levels of acute-phase proteins (ESRs)). The normalization of temperature and oxygen saturation was observed on day 3–4 in group 1 and on day 2 in group 2; normalization of leukocyte content and erythrocyte sedimentation rate was observed on day 12–13 and 7–8, respectively; and the acute phase indicators (C-reactive protein, fibrinogen) were normalized on day 7 and 5, respectively. Positive dynamics of chest X-ray analysis was observed on day 13 in patients of group 1 (the second control and the use of levofloxacin as alternative to the antibiotic previously used) and on day 8 in patients of group 2 (the first control).

Qualitative analysis of biological tuberculosis samples by an electronic nose-based artificial neural network.

To apply an e-nose system for monitoring headspace volatiles in biological samples from Egyptian patients with active pulmonary tuberculosis (TB) and healthy controls (HCs) and compare them with standard sputum analysis. The study population comprised 260 (140 males, 120 females) newly diagnosed TB patients and 240 (120 males, 120 females) HCs matched by age and socio-economic level admitted to hospitals specialising in chest diseases in Alexandria, Behera, Giza and Damietta Governorates, Egypt. Participants provided a history of TB and underwent clinical examinations, chest X-ray, and microbiological and e-nose analyses. Biological samples (blood, breath, sputum and urine) were collected. Being a confirmed TB patient was directly proportional to e-nose 10-sensor responses. Principal component analysis clusters showed a clear distinction between TB and HC groups, with variances of 93%, 85%, 75% and 95% for blood, breath, sputum and urine samples, respectively. Overall accuracy, sensitivity and specificity of the artificial neural network (ANN) analysis for classifying samples were >99%. The e-nose successfully distinguished TB patients from HC participants for all measured biological samples with great precision. With urine samples gaining broader acceptance for clinical diagnosis, an e-nose-based ANN can be a very useful tool for low-cost mass screening and early detection of TB patients in developing countries.

Testicular Tuberculosis with Tuberculoma of Brain in an HIV Negative Patient

Isolated testicular tuberculosis without renal or pulmonary involvement has not been reported much earlier. The case of a young HIV negative patient with testicular tuberculosis and tuberculoma of brain has been presented. A 32 years old normotensive, non-diabetic farmer presented to emergency facility with sudden onset of severe headache, vertigo and vomiting that developed over 24 hours and mild pain, swelling of right hemiscrotum associated with low grade fever for last one month. On examination, patient was conscious, oriented, pulse rate was 72/min, blood pressure was recorded 130/80 mm Hg, body temperature was 99 degree F, genital examination revealed swelling of right hemiscrotum with enlarged, firm and mildly tender right testis. He refused full neurological examination due to severe Journal of Bangladesh College of Physicians and Surgeons Vol. 34, No. 2, April 2016 headache and vertigo. MRI of brain revealed multiple, hyperintense, ring-enhancing lesions over right cerebellar hemisphere and corpus callosum. Aspiration of scrotal fluid revealed about 50 ml of yellowish pus, microbiology confirmed presence of few acid-fast-bacilli and plenty of pus cells. FNAC from right testicular mass revealed presence of granuloma and caseation necrosis. His chest X-ray and CSF analysis were normal, ESR was 20, USG of abdomen, hepatic and renal work-up was normal. Soon the patient was started with category I antituberculosis drug along with intravenous steroids. An excellent symptomatic improvement developed on 5th day of initiating drug therapy, he was closely monitored and followed up after discharge. This case report was prepared with his full consent.J Bangladesh Coll Phys Surg 2016; 34(2): 112-114

MA03.05 Cost Effectiveness Analysis of CT vs Chest X-Ray (CXR) vs No Screening for Lung Cancer (LC) in the PLCO and NLST Randomized Population Trials (RPTs)

NLST was the first RPT to demonstrate a significant LC mortality reduction, when comparing CT to CXR-screening. Consequently, CT-screening is now being incorporated into clinical practice. Nonetheless, questions about the value of CT-screening remain given costs of CT and workup of false-positives. A prior cost-effectiveness analysis of CT-screening using NLST data concluded that CT was generally cost-effective (NEJM:371,1793,2014). That analysis was performed under the assumption that CXR-screening only added costs without benefit. In an independent analysis of PLCO comparing CXR to no screening, we found that CXR-screening is associated with a highly significant LC survival advantage. This benefit was unrelated to conventional screening biases, including overdiagnosis. As CXR is less expensive than CT with a lower false-positive rate, its cost-effectiveness relative to CT should be assessed. Data from PLCO and NLST allows comparison of no screening, CXR, and CT. Costs of screening, diagnostic studies, and LC treatment were calculated based on original PLCO and NLST trial data obtained from NCI. These were estimated in 2015 US dollars from the Medicare perspective. Outpatient costs were calculated using the Medicare-2015B fee schedule. Inpatient costs were calculated using a national payment average by assigning a DRG based on procedures performed. Survival data was generated using the Kaplan-Meier method for each study and mean survival was calculated using available data. These estimates were used to calculate incremental cost per life-year gained The NLST-eligible subset of PLCO was also used to facilitate comparison of no screening, CXR, and CT. Analysis of PLCO data demonstrate that CXR compared to no screening was associated with a gain of 0.0152 life-years per person at an additional cost of $244 per-person for a cost per-life-year gained of $19,175. In the NLST-eligible subset of PLCO, CXR cost an additional $350 with a gain of 0.0262 life-years per-person for a cost-per-life-year gained of $13,377. In NLST, CT compared to CXR cost an additional $1,181 per-person and with a gain of 0.0157 life-years per-person, or $75,180 per-life-year gained. Using the NLST-eligible subset of PLCO for comparison, the ratio for CT compared to no screening was $36,552. CT-screening is both effective and cost-effective and represents the optimal method of screening for LC. However, the survival advantage associated with CXR-screening in comparison to no screening and relatively low cost make CXR a reasonable alternative to CT-screening, particularly in regions of the world where cost and availability limit access to CT-screening.

COMPUTED TOMOGRAPHY TO CONFIRM DELAYED RESIDUAL CHANGES IN LUNGS TISSUE OF A PROFESSIONAL FROGMAN

Peculiar diving disorders are characterized by pathological changes of lungs that are not always easy to identify and verify through X-ray. The article presents the clinical case of a professional frogman. X-ray scanning has been demonstrating changes in his lungs for many years. However, it was not considered as implications brought by high pressure in water and gas environments. The article gives a retrospective analysis of chest X-ray for the recent 13 years: both CT and spirography. CT reveals a limited zone of pneumothorax and two air-containing zones (aerocele) typical of pulmonary barotrauma. While medical examination of frogman, saturation diver and aquanaut it is highly reasonable to undergo computed tomography screening to verify morphological changes in lungs tissue and evaluate lesion volume.

Clinical Observation of neonatal hyaline membrane disease about the treatment injected into the"PS" by tracheal catheter

Objective To investigate the therapeutic effect of injectingPS by Scalp needle-induced tracheal catheter on treatment of neonatal hyaline membrane disease. Methods 26 cases were chosen as control group who were treated in our hospital NICU department during January,2013 to December,2013;the other 31 cases as improved group during January,2014 to January,2015.After administration therapy of drug,the injection time,chest X-ray and blood gas analysis were researched as observation indexes respectively. Results The amelioration of chest X-ray:29 cases in the improved group and 19 cases in the control group after 48 hours treatment,χ2= 4.457,P= 0.035;The amelioration of blood gas analysis:p H:(7.38±0.08)in improved group and(7.26±0.04)in the control group,t= 4.981,P= 0.030;PaCO2(mm Hg):(39±6)in the improved group and(50±10)in the control group,t= 5.897,P= 0.019;PaO2(mm Hg):(77±6)in the improved group and(67±10)in the control group,t= 8.026,P= 0.006. Conclusion The therapeutic effect of improved group is obviously better than the control group. Key words: Hyaline Membrane Disease; PS; Infant,Newborn

The evaluation of the dust-related occupational respiratory disorders of dental laboratory technicians working in Denizli Province.

INTRODUCTION:Dental laboratory technicians (DLTs) get exposed to fibrinogen dusts that are very risky dusts in terms of health. In this study, respiration complaints, pneumoconiosis frequencies and working conditions of the dental technicians in Denizli were investigated.METHODS:All of the registered DLTs working in Denizli were included in the study. A 30-item questionnaire was used to gather data about the participants and their working environments. Then, pulmonary function tests (PFTs) were carried out and standard chest X-rays were taken in order to detect how much the respiratory systems of the workers were affected. Standard chest X-rays were evaluated according to International Labour Organizations classification. Depending on the screening results, technicians who were found to have had pathologies and suspected cases were examined. “High-resolution computerized tomography (HRCT)” was taken from those who were found to have pathology in their chest X-rays and they were evaluated according to the classification of Hering et al.RESULTS:There are a total of 166 DLTs working in Denizli Province participated in the study. One hundred and forty-three (86.1%) of the participants were male, and 23 of them were female. The mean age of the participants is 33.5 ± 8.1. Average working time of the workers is 16 years. Total exposure time was calculated 36,177 h. Approximately, 56% of workers were smokers. When the working conditions were considered, it was found that 98.8% of laboratories had a ventilation system. Technicians’ use of personal protective equipment is low. Participants’ often or continuous use of masks, gloves, goggles, and vacuum device was found 69%, 36%, 47%, and 63% respectively while working. About 21.2% of the technicians have respiratory symptoms while 15.2% of them have eye complaints. At the analysis of PFT results, 27.7% restrictive type pulmonary disorder was determined. At the analysis of chest X-rays; 1/0 profusion sub-category was 25.5%, and the large opacity rate was 16.9%. Ten pneumoconiosis cases (6%) were diagnosed after the analysis of the HRCT results. The ratio of pneumoconiosis was found much higher among male technicians, particularly those who have been working for a long time in the profession and those working at the town hospitals and Department of metal leveling.DISCUSSION:Technicians’ use of personal protective tools is not enough and ratio of smoking is rather high. Pneumoconiosis cases clearly show this exposure. It is necessary to adopt comprehensive work health and safety precautions considering the determined risk factors.

Multiply Trauma in Children: Pulmonary Contusion does not Necessarily Lead to a Worsening of the Treatment Success

The aim of the study is to evaluate the impact of pulmonary contusion on the overall outcome in children with multiply injury. Retrospective review of 123 multiply injured children during a 10-year period (January 2000 to February 2010) who were admitted to the intensive care unit of a university affiliated, tertiary care pediatric trauma center. The diagnosis of pulmonary contusion (case group) was defined by the clinical context and the results of chest X-ray and blood gas analysis. Data were compared with a matched control group without the diagnosis of pulmonary contusion. Matching criteria were as follows: (1) age difference within 2 years; (2) sex; (3) similar injury pattern; (4) Pediatric Trauma Score (PTS) difference within 2 points; (5) Glasgow Coma Score (GCS) in two categories. The risk of pulmonary contusion must not be underestimated in multiply injured children. In our study, 49 of 123 patients (40%) showed signs of pulmonary contusion. A matched and pair analysis was performed in 46 patients (94%). Pulmonary contusion had an impact on the Pao2/ FIo2 ratio. It was significantly reduced in patients and caused insignificant extension of the ventilation time. Overall length of stay (LOS), LOS at pediatric intensive care unit, complication rate, mortality rate, and short-term outcome did not differ significantly between cases and controls. Pulmonary contusion alters gas exchange but does not appear to increase morbidity and mortality of pediatric patients with multiply injury. Interpretation may be limited by sample size.

Analysis of chest x-ray and clinical finding in children with pneumonia

Background and objective: The objectives of the study research were to determine the relationship between clinical and chest X-ray findings of pediatric patients. Methods: A Prospective clinical study carried out at Raparin hospital in Erbil city, Iraq. A sample of 356 children admitted between Decembers 2004 and June 2005 from emergency ward and inwards in Raparin hospital were collected with age range from 2 months to 10 years with mean age of 19 months. All children had chest radiography on the bases of clinical decision by pediatricians. Descriptive and statistical procedures were used to analyze the data. Results: All children had signs and symptoms of respiratory infections for instance, fever (87.4%), shortness of breath (99.5 %),cough (98%), tachypnea (73.5%), wheezes (93.3% ), chest retraction (80%), crepitations (82%) and, 42.4% of chest X-rays showed focal infiltrations. Three clinical parameters related to pneumonia diagnosed by chest X-ray these were, chest retraction with sensitivity of 80%, and specificity of 88.29%), tachypnea with sensitivity of 73.5% and specificity of 56.59% fever with sensitivity of 87.42% and specificity of 60.98%. Conclusion: Tachypnea, chest retraction and fever were found to be highly suggestive of pneumonia, chest x-rays was positive in about 425 of patients with pneumonia.

AB0740 Laboratory and imaging studies used by french rheumatologists to diagnose polymyalgia rheumatica

BackgroundThe BSR recommends for the diagnosis and management of polymyalgia rheumatica (PMR) blood cells count, blood electrolytes and renal function, liver function, bone metabolism tests, thyroid hormones, muscle enzymes, rheumatoid...

English

OBJECTIVE: To evaluate role of radio-imaging, with emphasis on MRI in comparison to other modalities, in patients of paediatric age group presenting with epilepsy and correlate it with clinical findings in Bundelkhand region. METHODS: Prospective data was obtained from evaluation of patients presenting with epilepsy in paediatric OPD and IPD, between 2010 and 2012. A total of 271 patients presenting with epilepsy (> 2 episodes of seizures) were included. CBC, Chest X-ray and CSF analysis were also performed for clinical evaluation as per need. Neurosonogram was done in 41 children below age of 1year (15.1%), Head CT was obtained in 167 (61.7%), MRI in all cases. EEG was done in all cases, except in 5 cases of trauma. Epilepsy provoked by causes such as fever, electrolyte imbalance and dehydration were excluded. RESULTS: We observed that generalized seizures were more common presentation, followed by partial seizures, mostly complex. Majority had more than 2 episodes of seizures at the time of presentation. MRI revealed positive findings in 191 cases (70.4%) and CT in 64 cases (38.3%) of 167 done. MRI had positive findings in 35 cases (34.0%) of 103 with normal CT scan. Most common cause of epilepsy in this region was found to be CNS tuberculosis (Tuberculomas, 15.7% & TBM, 14.6%), followed by Neurocysticercosis (11.0%), Encephalitis (7.9%), Demyelination (6.8%), Gliosis with or without Encephalomalacia (6.8%), Periventricular leukomalacia (5.2%), Infarct (4.7%) & porencephaly (3.7%). Rare causes observed were leukodystrophy (7cases), intra-axial bleed (4 case) and extra-axial bleed (5case), heterotopias (4 case), abscess (2case) and Phakomatosis (Tuberous Sclerosis, 1 case). CONCLUSION: Since most of the seizures begin in paediatric age-group, which is crucial time for physical, psychosocial & mental growth, it is essential to evaluate the diverse varieties of aetiologies and manage patient accordingly. MRI thus proves to be the best for almost all pathologies, causing epilepsy, except trauma. INTRODUCTION: Epilepsy is common sparing no age, race or ethnic background. The incidence of epilepsy is 1% [1], making it a common neurological condition. Epilepsy is first most common chronic condition seen by a paediatrician and second most common neurological condition seen by neurologists. It has lot of psychological, social and functional inabilities in children affected and their families.

In need of something better than sleep

In July, 2010, a 32-year-old woman was refered to us with history of mild fever and headache. She had no other symptoms and signs and initial clinical examination and laboratory tests including chest X-ray and urine analysis were done to find the origin of fever. Results of the examination and laboratory tests were negative, and aseptic meningitis was suspected. Cerebrospinal fluid showed 125 cells (64% neutrophils and 27% lymphocytes) and protein and glucose at 0·57 g/L and 3·28 mmol/l, respectively.

Giant teratoma of anterior mediastinum in a 14-year-old girl as an example of potential diagnostic problems and errors

Teratomas are tumors originating from the three primary germ layers, most commonly located within gonads or in the sacral region. Chest locations are rare. Mediastinal teratoma showing no tumor-specific symptoms may be treated as exudative pneumonia. The goal of the article was to present a case encountered in our practice as a showcase of possible diagnostic problems and errors. Despite a thorough medical examination with additional exams (ultrasound scans of pleural cavities, chest X-ray and laboratory analyses), the diagnosis of a thoracic tumor was made only after chest computed tomography scan was performed following ineffective attempts at antibiotic therapy and pleural drainage. Following the diagnosis of mediastinal tumor, the patient was subjected to surgery. A giant teratoma (confirmed in histopathological examination) was removed upon left-sided thoracotomy. Following the procedure, lung expansion and patient recovery were observed. Computed tomography of the chest should be performed routinely upon encountering difficulties in the treatment of exudative pneumonia in children. In every case of pneumonia with pleural effusion in children, inflammatory mask of mediastinal tumors should be ruled out.